"Health" itself is an implicitly political concept (see, for example, body positive movement) and there's no escaping that. And Joe Blow M.D. will always be accorded more respect when talking about health to a lay audience. No escaping that either. That's different, though, than campaigning in the exam room. So I think there are two different definitions, or shades, of "politics" being discussed here and it causes some confusion. I need to stay away from the comment section.
Dr Huddle is right. Doctors should have well-informed political views and they should be able to express them when they wish. The balance is that patients do not come to the clinic to be lectured about their political choices. Nor do they see their doctor to be brow-beaten about the stupidity of their voting preferences. They come to get their blood pressure under control, or their statin dose adjusted or to schedule their colonoscopy. There is a right place and a right time to discuss politics. The clinic might not be such a time or place.
Completely agree. This is the most incisive and well reasoned argument in the debate. Many of the problems we saw during Covid resulted from doctors with no expertise in public health or understanding of statistics stepping well outside their wheelhouse, causing unnecessary fear and anxiety in the public and supporting courses of action that ended up harming rather than helping many people. If we had stuck to doing our job, as Thomas so eloquently describes, of assisting the individual in front of us with their individual needs, outcomes would most likely have been better for everyone.
I've not read all of the debate (nor the comments) but I think Dr. Huddle misses an important point when he states:
"Physicians may campaign against nuclear weapons or fossil fuels or for motorcycle helmet laws and gun control. Their standing as physicians may give them special insight into what one side of the tradeoff may be for a given policies but none into whether the tradeoff is worth making. On that political matter physician judgment is on the same plane as that of any other citizen."
Physicians are experienced at dealing with the facts of life (death happens even to the young) and the consequences of incorrect evaluations or actions. Medical errors cost lives and disability and most of us have learned from experiences that we regret. Our roles tend to be long-term, unlike many political leaders (exception: the US Senate gerontocracy and near-Presidential gerontocracy).
The best physicians seek truth in accurate diagnosis and refutation of hypotheses that can be disproven. Not so most politicians - although a few of the best may be remarkably open minded.
I think this is a major reason why physician leaders like PSR (founded 1962, evolved into International Physicians for the Prevention of Nuclear War) faced the reality of the implications of using nuclear weapons, in a manner that many politicians did not.
The same can be said of physician-led campaigns against smoking, in favour of seat belts, bicycle and motorcycle helmets, gun control, etc. We see directly the awful consequences of dangerous behaviours and deal with the grief of families and friends - unavoidably. This is obviously no so for many politicians.
I think it's worth asking how many major improvements in public health would not have happened without physician leadership for reforms. I can think of many in British Columbia and Canada.
Tom Perry MD, FRCPC
University of British Columbia Faculty of Medicine
Not a comeuppance but another interesting perspective with great insight. Hoping to see a continued debate/discussion regarding public health (without attacking individuals). Certainly doctors must involved with these decisions and are capable of working together with experts in other disciplines to work out how to balance the trade offs. No science is not religion and neither is politics. So important to remember the science is never settled.
I’m glad we are to the main criticism, and you have seen it’s a direct story, not one from down the rabbit hole. I saw the clip played on GB news, however I don’t have time to search their archives to find it for you. The point you had made is that I was siting fake news, now that we know I wasn’t, I happier. I totally agree with you on the proliferation of fake news, even the MSM is guilty of it, however I did listen to her actual words, so felt comfortable siting it as an example. Cheers, Lauren
My doctors were political with me during COVID. Demeaning my choice to take the vaccine I chose and refusing to take more. Dropping me as a patient because I refused to take vaccine after vaccine that came out. Telling me I had to get the vaccine to advocate for my husband should he be hospitalized for his Parkinson’s. I had to be anti-vax and a Trump supporter. Interestingly enough, I was neither.
My history with vaccines is bad. She could have recognized that as my current doctor has that I should probably stay away from certain ones. Instead, she demeaned me as someone who was just acting politically by not taking them. The Yellow Fever vaccine damn near killed me. Still have deficits from it. In retrospect, I should have stood my ground. Bad reaction to the vaccine. She had to have been pressured by the health system she was part of. When I met with her before I took the shot, she was in full protective gear, goggles, surgical mask, gloves, plastic face shield, disposable gown, booties. I still think it was to intimidate me as she shed this behind going into the next patient’s room, except for the mask.
Doctors have every right to engage in politics. IMO they should appear apolitical to patients. Can they treat patients with whom they disagree? I found out that they could not. Perhaps that was at the behest of the system. I now view all doctors with suspicion and share nothing with doctors outside of the reason for the visit. As a result, we don’t get to view each other as individuals. It’s a shame. But, the way it is until something changes.
We will regret politicizing everything in our lives.
Doctor Huddle has gone directly to the heart of the matter, with his assessment of the distinction between public health and a physician's duty to individual patients in the treatment setting.
Of necessity and by definition, public health is a utilitarian calculus. Framed within the context of the classic trolley problem; public health officials will always pull the lever, deliberately and knowingly killing the few in order to (possibly) spare the lives of the many.
We saw this during the house arrest advocacy period. Public health officials, however stupidly they presented themselves by means of calculated elision, are not stupid. They know very well that poverty kills, but gambled that fewer would die from the homelessness and hunger that inevitably follow denying citizens the right to work, than would die from the novel virus that so terrified them.
We trust physicians and pay them handsomely to treat each of us for our own ailments. When physicians use their credentials as leverage to assert political domination, they betray that trust and fail to provide value for the money we pay them.
Whether the declining trust in the medical industry is owing to a tragedy or a crime, will be the subject of much discussion for a very long period of time.
That activist physicians may learn to avoid the moral hazard attendant to the category error described above, is an eventuality most fervently to be desired. Trust will continue to decline until that worthy goal has been attained.
Agree with Dr Huddle: medicine is a unique art-science based discipline and orthogonal to the political process. When the line is crossed we have e.g. a government agency reporting the disparity (black-white) between covid deaths as caused by systemic racism while at the same time, ignoring the better survival rates between Asian-white groups. Stick to healing and treating the unwell according to medical principles and ethics...
Ugh I have a headache over all of the political stuff. We are drowning in it. Which pharma company will pay me the most, by the way, to claim their meds will help this awful headache?
While I agree that in some situations it would be inappropriate to use one's degree or profession to imply a greater level of authority than one actually possesses, I think there may be some political issues where it would be very, very difficult - and perhaps disingenuous - to try to separate being a doctor from being a political activist or citizen.
Specifically, I'm thinking of abortion and the right to choose - I don't believe that all physicians should be mandated to comment on this issue, but I do believe that taking a political stance on this subject - without also incorporating the simple medical fact that some pregnancies are not viable, and limiting access to safe abortion puts the pregnant patient's life at risk - has the potential for immense harm if the stance is perceived as coming from a physician. Again, I don't think that all doctors should be forced to speak on this issue, nor should all providers be mandated to perform an abortion if it's not something they're comfortable doing, but if they choose to participate in this discourse, even if they personally do not support abortion rights, shouldn't they also acknowledge the medical facts of the issue?
Personally, I'm of the opinion expressed in the second paragraph - whether we like it or not, we're doctors, with all of the cultural baggage and connotations that title carries. That doesn't necessarily mean that doctors must always participate in political discourse, but in my opinion, it does mean that if we choose to make known our political opinions, we must also acknowledge that we're doctors - whether it's inconvenient or not.
When MDs navigate the slippery political slope of being politically compelled to maim (providing transgender hormone treatments and surgeries to minors), disfigure mentally dysphoric adults by creating faux sexual organs and implanting developing fetus into into the belles of a Men, they have significantly diverged from “do no harm” into the title of Dr Frankenstein. Stick to the oath. There is no political allegiance inferred within it. Diverge from the oath, and enter the darkness of man.
Excellent analysis of the issue. Stay in your lane. Do your job. If asked my opinion, I will always tell the truth. I detest all politicians. On any given issue, I will always support the position that promotes individual liberty. "Public health" is a mythical collectivist concept and has no place in the highly individualistic profession of medicine.
"Health" itself is an implicitly political concept (see, for example, body positive movement) and there's no escaping that. And Joe Blow M.D. will always be accorded more respect when talking about health to a lay audience. No escaping that either. That's different, though, than campaigning in the exam room. So I think there are two different definitions, or shades, of "politics" being discussed here and it causes some confusion. I need to stay away from the comment section.
Dr Huddle is right. Doctors should have well-informed political views and they should be able to express them when they wish. The balance is that patients do not come to the clinic to be lectured about their political choices. Nor do they see their doctor to be brow-beaten about the stupidity of their voting preferences. They come to get their blood pressure under control, or their statin dose adjusted or to schedule their colonoscopy. There is a right place and a right time to discuss politics. The clinic might not be such a time or place.
Completely agree. This is the most incisive and well reasoned argument in the debate. Many of the problems we saw during Covid resulted from doctors with no expertise in public health or understanding of statistics stepping well outside their wheelhouse, causing unnecessary fear and anxiety in the public and supporting courses of action that ended up harming rather than helping many people. If we had stuck to doing our job, as Thomas so eloquently describes, of assisting the individual in front of us with their individual needs, outcomes would most likely have been better for everyone.
I've not read all of the debate (nor the comments) but I think Dr. Huddle misses an important point when he states:
"Physicians may campaign against nuclear weapons or fossil fuels or for motorcycle helmet laws and gun control. Their standing as physicians may give them special insight into what one side of the tradeoff may be for a given policies but none into whether the tradeoff is worth making. On that political matter physician judgment is on the same plane as that of any other citizen."
Physicians are experienced at dealing with the facts of life (death happens even to the young) and the consequences of incorrect evaluations or actions. Medical errors cost lives and disability and most of us have learned from experiences that we regret. Our roles tend to be long-term, unlike many political leaders (exception: the US Senate gerontocracy and near-Presidential gerontocracy).
The best physicians seek truth in accurate diagnosis and refutation of hypotheses that can be disproven. Not so most politicians - although a few of the best may be remarkably open minded.
I think this is a major reason why physician leaders like PSR (founded 1962, evolved into International Physicians for the Prevention of Nuclear War) faced the reality of the implications of using nuclear weapons, in a manner that many politicians did not.
The same can be said of physician-led campaigns against smoking, in favour of seat belts, bicycle and motorcycle helmets, gun control, etc. We see directly the awful consequences of dangerous behaviours and deal with the grief of families and friends - unavoidably. This is obviously no so for many politicians.
I think it's worth asking how many major improvements in public health would not have happened without physician leadership for reforms. I can think of many in British Columbia and Canada.
Tom Perry MD, FRCPC
University of British Columbia Faculty of Medicine
Kudos, great contribution.
Beautifully written. Thank you for making this important distinction. So many doctors need to read this, and medical schools need to teach it.
This is so well written. Thank you for contributing and sharing.
Excellent and thorough overview! Thanks for posting this.
Not a comeuppance but another interesting perspective with great insight. Hoping to see a continued debate/discussion regarding public health (without attacking individuals). Certainly doctors must involved with these decisions and are capable of working together with experts in other disciplines to work out how to balance the trade offs. No science is not religion and neither is politics. So important to remember the science is never settled.
I’m glad we are to the main criticism, and you have seen it’s a direct story, not one from down the rabbit hole. I saw the clip played on GB news, however I don’t have time to search their archives to find it for you. The point you had made is that I was siting fake news, now that we know I wasn’t, I happier. I totally agree with you on the proliferation of fake news, even the MSM is guilty of it, however I did listen to her actual words, so felt comfortable siting it as an example. Cheers, Lauren
My doctors were political with me during COVID. Demeaning my choice to take the vaccine I chose and refusing to take more. Dropping me as a patient because I refused to take vaccine after vaccine that came out. Telling me I had to get the vaccine to advocate for my husband should he be hospitalized for his Parkinson’s. I had to be anti-vax and a Trump supporter. Interestingly enough, I was neither.
My history with vaccines is bad. She could have recognized that as my current doctor has that I should probably stay away from certain ones. Instead, she demeaned me as someone who was just acting politically by not taking them. The Yellow Fever vaccine damn near killed me. Still have deficits from it. In retrospect, I should have stood my ground. Bad reaction to the vaccine. She had to have been pressured by the health system she was part of. When I met with her before I took the shot, she was in full protective gear, goggles, surgical mask, gloves, plastic face shield, disposable gown, booties. I still think it was to intimidate me as she shed this behind going into the next patient’s room, except for the mask.
Doctors have every right to engage in politics. IMO they should appear apolitical to patients. Can they treat patients with whom they disagree? I found out that they could not. Perhaps that was at the behest of the system. I now view all doctors with suspicion and share nothing with doctors outside of the reason for the visit. As a result, we don’t get to view each other as individuals. It’s a shame. But, the way it is until something changes.
We will regret politicizing everything in our lives.
Doctor Huddle has gone directly to the heart of the matter, with his assessment of the distinction between public health and a physician's duty to individual patients in the treatment setting.
Of necessity and by definition, public health is a utilitarian calculus. Framed within the context of the classic trolley problem; public health officials will always pull the lever, deliberately and knowingly killing the few in order to (possibly) spare the lives of the many.
We saw this during the house arrest advocacy period. Public health officials, however stupidly they presented themselves by means of calculated elision, are not stupid. They know very well that poverty kills, but gambled that fewer would die from the homelessness and hunger that inevitably follow denying citizens the right to work, than would die from the novel virus that so terrified them.
We trust physicians and pay them handsomely to treat each of us for our own ailments. When physicians use their credentials as leverage to assert political domination, they betray that trust and fail to provide value for the money we pay them.
Whether the declining trust in the medical industry is owing to a tragedy or a crime, will be the subject of much discussion for a very long period of time.
That activist physicians may learn to avoid the moral hazard attendant to the category error described above, is an eventuality most fervently to be desired. Trust will continue to decline until that worthy goal has been attained.
Agree with Dr Huddle: medicine is a unique art-science based discipline and orthogonal to the political process. When the line is crossed we have e.g. a government agency reporting the disparity (black-white) between covid deaths as caused by systemic racism while at the same time, ignoring the better survival rates between Asian-white groups. Stick to healing and treating the unwell according to medical principles and ethics...
Ugh I have a headache over all of the political stuff. We are drowning in it. Which pharma company will pay me the most, by the way, to claim their meds will help this awful headache?
While I agree that in some situations it would be inappropriate to use one's degree or profession to imply a greater level of authority than one actually possesses, I think there may be some political issues where it would be very, very difficult - and perhaps disingenuous - to try to separate being a doctor from being a political activist or citizen.
Specifically, I'm thinking of abortion and the right to choose - I don't believe that all physicians should be mandated to comment on this issue, but I do believe that taking a political stance on this subject - without also incorporating the simple medical fact that some pregnancies are not viable, and limiting access to safe abortion puts the pregnant patient's life at risk - has the potential for immense harm if the stance is perceived as coming from a physician. Again, I don't think that all doctors should be forced to speak on this issue, nor should all providers be mandated to perform an abortion if it's not something they're comfortable doing, but if they choose to participate in this discourse, even if they personally do not support abortion rights, shouldn't they also acknowledge the medical facts of the issue?
Personally, I'm of the opinion expressed in the second paragraph - whether we like it or not, we're doctors, with all of the cultural baggage and connotations that title carries. That doesn't necessarily mean that doctors must always participate in political discourse, but in my opinion, it does mean that if we choose to make known our political opinions, we must also acknowledge that we're doctors - whether it's inconvenient or not.
When MDs navigate the slippery political slope of being politically compelled to maim (providing transgender hormone treatments and surgeries to minors), disfigure mentally dysphoric adults by creating faux sexual organs and implanting developing fetus into into the belles of a Men, they have significantly diverged from “do no harm” into the title of Dr Frankenstein. Stick to the oath. There is no political allegiance inferred within it. Diverge from the oath, and enter the darkness of man.
Excellent analysis of the issue. Stay in your lane. Do your job. If asked my opinion, I will always tell the truth. I detest all politicians. On any given issue, I will always support the position that promotes individual liberty. "Public health" is a mythical collectivist concept and has no place in the highly individualistic profession of medicine.
Absolutely.